An 83-year-old man presented with a 5-year history of an eruption that had begun on his left heel and had progressed over the next several years to involve both hands and feet. The eruption had been asymptomatic except for occasional pruritus. The patient also noted pain and enlargement of his left great toe for approximately 2 weeks.
Physical examination revealed multiple dusky, violaceous plaques on the palmar and dorsal aspects of the hands, with areas of sparing on the fingers and palms (Figure 1). There were focal areas of scale, fissuring, and ulceration. No nail involvement was present. Similar plaques were also present on the dorsal and plantar aspects of both feet, with swelling, erythema, and tenderness of the left great toe. Diffuse onychomycosis of the toenails was noted. Physical examination revealed no other lesions, and no lymph nodes were palpated. A potassium hydroxide preparation of foot scrapings revealed significant fungal hyphae; however, scrapings from the hands were negative for organisms. A 4-mm punch biopsy specimen was obtained from a plaque on the hand (Figure 2 and Figure 3).
Lambert TJ, Prieto VG, Duvic M. Multiple Plaques on the Hands and Feet. Arch Dermatol. 2007;143(1):109-114. doi:10.1001/archderm.143.1.109-a